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Participant Name___________________________________________________________________

Address _________________________________________________________________________

City, State, Zip_____________________________________________________________________

Telephone No. (home) ____________________________ (cell) __________________________

Email Address ___________________________________________________________________

Date of Birth _____________________ Team ________________________________________

EMERGENCY CONTACT NAME & NO. ______________________________________________________

ALLERGIES/MEDICAL CONDITIONS _______________________________________________________

I, the undersigned (if applicant/participant is 18 years of age or older) or parent/guardian of the above

listed minor applicant/participant acknowledge and fully understand that each applicant/participant will

be engaging in activities that involve risk of serious injury, including permanent disability or death, and

severe social and economic losses which might result not only from their own actions, inactions or

negligence but action, inaction or negligence of others, the rules of play or the condition of the premises or

of any equipment used and further that there may be other unknown risks not reasonably foreseeable at

this time, assume all the foregoing risk and accept personal responsibility for the damages following such

injury, permanent disability or death, hereby release, discharge, covenants to indemnify and not sue

Walker Athletics & Sports Performance Complex, Walker Holding Group, its affiliated organizations and

sponsors, employees and associated personnel, officers, directors, agents including the owners and leasers

of premises used to conduct the event, all of which are hereinafter referred to as releasees from any and all

liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on

behalf of the applicant as a result of the applicant’s participation in the programs and/or being transported

to or from the same which participation after careful consideration I hereby authorize and which

transportation I hereby authorize.

 I also agree to save and hold harmless and indemnify each and all parties herein referred to above as release from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said release because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the releasee. I have read the above and understand that (I) we have given up substantial rights by signing this release and sign below voluntarily.

By signing this waiver, the undersigned understands that s/he may be photographed or videotaped at any

Walker Athletics program or event. I give permission for photographs and videotapes of my child/me to be

used to promote Walker Athletics through press releases, brochures, the web site(s) and other promotional

materials. Such photographs and videotapes will remain the property of Walker Athletics.


I agree a facsimile, photocopy or email copy shall have the same legal effect as an original form signature.


Parent (if under 18) or participant signature Date